According to a report in the Journal of the American Heart Association, “More than 60% of patients decline participation in cardiac rehabilitation after a myocardial infarction.” This likely plays a significant role in the overall prognosis – “Approximately 1 of 4 survivors of an acute coronary event will experience another cardiovascular event or die within the following 5 years.”
The good news is that the prognosis CAN be changed! The changes made during recovery from an acute coronary event can have a significant impact on the patient’s life going forward.
“Smoking cessation rates of 60% are reported in long‐term smokers in the period immediately after a diagnosis of myocardial infarction.” Physical Activity (PA) is another critical factor where patients can make significant strides toward improving their prognosis. There is significant evidence showing that physical activity “delays the development of atherosclerosis and is associated with reduced risk of future coronary events… Each 1 metabolic equivalent (MET) increase in fitness is associated with a 19% decrease in the risk of cardiovascular mortality”.
Cardiac rehabilitation programs use this time period to help patients make behavior modifications to increase their activity level and reduce risk of another cardiovascular event. Unfortunately, in the US less than 40% of the eligible patients take advantage of this opportunity.
The least likely to enroll include “Older men, women of all ages, and ethnic minorities”. Reasons given for non-enrollment include “dislike of exercise, perception of exercise as tiring or painful, low exercise capacity, travel distance, high copays, . . . depression and low social support.” Some patients even expressed a fear that cardiac rehab was dangerous.
Even after enrollment, some dropped out citing “limited number of available exercise options to the lack of social interactions during programs.” This has led to a search for other options beyond the current programs offered.
Enter Tai chi. This Chinese martial art is based on gentle movements along with relaxation and a focus on breathing. As such, it does not have the reputation of being strenuous like the treadmill or traditional aerobic classes. Tai chi is showing promise as an alternative for cardiac patients for several reasons:
- The intensity can be adjusted in numerous ways including length of session, body position and style.
- Tai chi is safe enough to be offered in community centers, civic centers, etc. making it more accessible for some patients for whom travel distance is a factor.
- Because it is so gentle, it may be more appealing to women and others who do not enjoy the types of exercise generally offered at cardiac rehabilitation.
- In spite of being gentle, the energy expenditure can reach 4.6 metabolic equivalents which is considered moderate intensity aerobic activity.
- The emphasis on breathing and relaxation may help with stress and other psychological issues that negatively affect health.
Because there is no known study that evaluates if tai chi should be promoted and offered as an alternative exercise for cardiac rehab, researchers “conducted a phase 2 study to determine safety and which dose of tai chi is most feasible, acceptable, and safe (primary outcome) and to obtain preliminary estimates of the effect of each dose on PA and aerobic fitness (secondary outcomes). Other secondary outcomes included quality of life (QOL) and body weight.”
Participants were adults over the age of 21 (average age 67) with a history of coronary heart disease and who were physically inactive (less than 30 minutes of moderate-intensity 5 days a week or 20 minutes of vigorous activity 3 days a week). They completed baseline assessments and were evaluated by a cardiologist for final clearance.
The group was then divided into 2 groups: LITE and PLUS.
o LITE – 2 sessions per week for 12 weeks
o PLUS – 3 sessions per week for 12 weeks, then 2 classes per week for 3 weeks, then 1 class every other week for 8 weeks.
Both the LITE and PLUS group participants were instructed to practice tai chi at home 3 times per week with a 30 minute DVD provided by the researchers. The exercises done in classes and on the DVD were the same for both groups. The specific exercises were modified specifically for this study in order to slowly increase the intensity over time as the study progressed. Assessments were repeated at 3, 6 and 9 months after the patient began.
Overall, the results of the study were encouraging.
- Retention was 90% at the 9 month follow-up
- Patient ratings showed high satisfaction (95% said it was “enjoyable”)
- Patients said they would recommend it to a friend (100%)
- NO cardiac adverse events occurred during the study. Most common adverse events were musculoskeletal, but not related to tai chi.
There were some differences between the LITE and PLUS groups.
- Average weight loss was higher in the PLUS group and was maintained from 3-9 months.
- Quality of Life scores for PLUS group were significantly better at 3 months than the LITE group.
- PLUS group also showed a continued increase in physical activity compared to the LITE group.
Researchers determined that while both schedules of tai chi improved patient condition, the longer intervention gave more benefits. The study participants were significantly deconditioned and the tai chi was shown to be safe for that population, “provided that participants are screened following the same criteria adopted for cardiac rehabilitation.”
Additionally, benefits were seen in smokers and obese individuals who had already established a resistance to change by continuing unhealthy habits in spite of their history of coronary heart disease. The study showed significant improvements in both light and moderate physical activity, even at 9 months.
Maintaining a lifestyle with physical activity is vital to overall health and especially cardiac wellness. If you are not currently active, talk to your chiropractor about what types of exercise might be most beneficial for you. A gentle exercise such as tai chi could be an excellent place to start!
SOURCE: “Tai Chi Is a Promising Exercise Option for Patients With Coronary Heart Disease Declining Cardiac Rehabilitation” published in Journal of the American Heart Association, October 11, 2017 http://jaha.ahajournals.org/content/6/10/e006603